Nursing Bullets: Medical-Surgical Nursing Part VI

If a patient who is taking an oral contraceptive misses a dose, she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule.

If a patient who is taking an oral contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week.

Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension.

In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode.

Treatment for abruptio placentae is usually immediate cesarean delivery.

Infants with Down syndrome typically have marked hypotonia, floppiness, slanted eyes, excess skin on the back of the neck, flattened bridge of the nose, flat facial features, spadelike hands, short and broad feet, small male genitalia, absence of Moro’s reflex, and a simian crease on the hands.

The failure rate of a contraceptive is determined by the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 woman-years.

The narrowest diameter of the pelvic inlet is the anteroposterior (diagonal conjugate).

The chorion is the outermost extraembryonic membrane that gives rise to the placenta.

The corpus luteum secretes large quantities of progesterone.

From the 8th week of gestation through delivery, the developing cells are known as a fetus.

In an incomplete abortion, the fetus is expelled, but parts of the placenta and membrane remain in the uterus.

The circumference of a neonate’s head is normally 2 to 3 cm greater than the circumference of the chest.

After administering magnesium sulfate to a pregnant patient for hypertension or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes.

During the first hour after birth (the period of reactivity), the neonate is alert and awake.

When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonography rules out placenta previa.

After delivery, the first nursing action is to establish the neonate’s airway.

Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered.

The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity suggests overhydration; a higher one suggests dehydration.

The neonatal period extends from birth to day 28. It’s also called the first 4 weeks or first month of life.

A woman who is breast-feeding should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking.

After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth with sterile water.

The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by gonorrhea or chlamydia.

Human immunodeficiency virus (HIV) has been cultured in breast milk and can be transmitted by an HIV-positive mother who breast-feeds her infant.

A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection.

Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature.

During labor, the resting phase between contractions is at least 30 seconds.

Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth.

Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth.

Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth.

Colostrum, the precursor of milk, is the first secretion from the breasts after delivery.

The length of the uterus increases from 2½” (6.3 cm) before pregnancy to 12½” (32 cm) at term.

To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass.

The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the transverse diameter between the ischial tuberosities.

Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample.

In an emergency delivery, enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull.

After delivery, a multiparous woman is more susceptible to bleeding than a primiparous woman because her uterine muscles may be overstretched and may not contract efficiently.

Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome.

The nurse should suggest ambulation to a postpartum patient who has gas pain and flatulence.

Massaging the uterus helps to stimulate contractions after the placenta is delivered.

When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital area.

The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor.

In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions.